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heme > Anemias > Flashcards

Anemias Flashcards

1
Q

Iron Deficiency

A

Reason: low iron

Symptoms: anemia, Pica (ice chewing), Angular cheilits ( corner mouth sores), Restless legs

Etiologies: GI losses, elsewhere bleeding, menstration, malabsoprtion, decreased intake

LABS: Down: MCV, Retics, ferritin (acute phase could look normal), Iron, Transferrin saturation
increase: TIBC, sTfR, Pencil looking cells

Microcytic

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2
Q

Iron treatment

A

PO: need to be with acid to change into active form
IV: for people with low compliance or immediate need or low compliance

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3
Q

Thalassemia

A

Reason: inherited mutaion in ⍺ or β heme chain

Symptoms: Microcytic anemia, hypochromic with cell that look like targets

Eitologies: Hb electro or genetic testing the best

Labs: MCV disporpotionally low, target looking cells, Hb electro - ⍺ β shows up different

microcyctic

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4
Q

Alpha Thalassemia

A

Gene
1. silent 3/4 - no change
2. a-/a- (alpha Th), aa/– (minor Th) - minor 10-14 Hbg no transf
3. -a/– hemo H disease - inter 6-10Hgb maybe need transf
4. –/– - death

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5
Q

Beta Thalassemia

A

GENE:
1. minor b/b+, b/bo - minor 10-14
2. inter b+/b+,b+/bo - inter 10-6
3. major bo/bo - major 6-3

b+ great variablity but bo is just absent

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6
Q

Thalassemia Treatment

A

RBC transfusion, Iron chelation, Hydroxyuera, gene therapy

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7
Q

Siderblastic anemia

A

Reason: can incorporate iron into Hb

Symptoms: Erythroblasts (pre-RBC) with iron in the mitochondria

Etiologies: Genetic or acquired, MDS, Copper def, lead poisoning

Labs: blue stained RBC that show the iron around the mitochondria

microcyctic

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8
Q

Megaloblastic anemia

A

Reason: B12 defi, folate def (uncommon)

Symptoms: RBC large bc they didnt divied bc of DNA systhesis probelms

Etiologies:

Labs: MCV > 100, hypersegmented neutrophils ( many lobes not just 3)

Macrocyctic

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9
Q

Importance of B12 and Folate

A

Cofactors in DNA synthesis to help methylation
B12 absorption - take up in stomach and procced all the way to Small Intes - 50% liver 50% other tissues

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10
Q

B12 deficiency Causes and Signs

A
  1. Strict veganism
  2. Lack of intrinsic factors (percoius anemia), Gastrectomy, H. pylori, proton pumps, H2 blockers
  3. Absporption
  4. Congenital causes

Signs: Macrocyctic anemia, Hypersegmented nuetro, High methymelonic acid

symptoms: Neuropathy(

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11
Q

Pernicious anemia

A

Reason: B12 deficiency

Symptoms: Low B12, Parietal antibodies, Intrisic factors

Etiologies: autoimmune disease agaisnt stomach cells, loss of gastric glands, loss of gastic acid and intrinsic factors

Labs:

Population: above 60 and women>men

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12
Q

Folic acid deficiency

A

Reasons:
1. low diet intake
2. drugs ( folate antagonis, methotrexate)
3. jejunum malabsportion - crohn;’s celiac
4. increased demand, Preg and hemolytic anemias

Signs:
1. Macrosystic anemia
2. Hypersemented nuetrophils
3. **NORMAL METHYMELONIC ACID

symptoms: NO NEUROPATHY

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13
Q

What are other causes of Macrocytosis

A
  1. retics bigger than RBC
  2. alcholism/liver
  3. COPD
  4. Hyperthyroidism
  5. Drugs - Chemo, Sulfa, Triamterene, Anticonvulsants, Valporic acid
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14
Q

Myelodysplastic Syndrome

A

Reason: mutations in myeloid precursers

Symptoms: Cytopenias, MCV >100

Etiologies: Ineffective hematopoiesis in marrow, lots of cells but malformed

Labs:

Risk factors - age, Benzene exposure, chemotherapy

Macrocytic

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15
Q

Normocyctic Anemia

A

Reason: Diease/ inflamation

Symptoms: Decreased RBC, Hepcidin (reduction in plasma iron, so iron builds up even though enought just BM cant use non-plasma, Cant respond to EPO, low EPO

Etiologies: Age, Chronic infections, HIV, maliganacy, Diabetes, RA

Labs: ESR and CRP | Ferritin up, Hepcidin up, Iron down, TIBC low or normal, Transferrin down, sTfR normal (simlar to iron def but some changes)

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16
Q

Renal Failure Anemia

A

Normocyctic like
EPO problems
All dialysis need EPO replacements

17
Q

Sequestration Anemia

A

Splenomegaly:
1. thalassemia major
2. Cirrohosis with portal HTN
3. Gaucher disease
4. Malignancies

Normocytic anemia

18
Q

Blood loss Anemia

A

low CBC and RBC, increase reticues only if given enough time to build up

19
Q

Hemolytic Anemia Genralized

A

Hemolysis (death of RBC cells outside of marrow), Extravascular (outside of vascular like spleen), Intravascular ( circulation/blood vessels)

can be aquired or born with

What to look for: Fatigue, pale, jaundice, dark urine, gallstones, Big spleen, family history

IN ALL HEMOLOTIC EVENTS - increased bilirubin, lactate dehydrogenase, RPI >3

Caveats: Bilirubin up is in various liver disorders, bili and LDH elevated in EPO inefficency

20
Q

Intravascular vs Extravascular Hemolysis

A

same for reti, LDH and Bili
blood in urine is up for Intravascular but Haptoglobin is undetectable

Intra: Reticulocytes do not increase for days and peak in 1 week

21
Q

Congenital/Hereditary disorder lead to which Hemolysis?

A

Extravascular hemolysis (mostly spleen, sometimes liver)
Autosomal dominate
Suffers from Anemia, Jaundice, splenomegaly and pigemnted gallstones
3 abnormalities
1. Spherocytosis - MOST COMMON
2. Elliptocytosis
3. Stomatocytosis

Decteable by Peripheral smear

22
Q

Hereditary Spherocytosis

A

Reason: Extavasular hemolysis (RBC death)

Symptoms: anemia, jaundice, fatigue, pigmented gallstones

Etiologies: Def membrane (spectrin, ankyrin or band 3), this causes sphere shape and target of phagocytosis

Labs:

Crisis:
1. Hemolytic crisis - common in children
2. Aplastic crisis - viral infection B19
3. Megoblastic - increase folate demands, preg child elderly

Hemolytic

23
Q

Herditary elliptocytosis

A

Meditarranean or african ancestry
alpha or beta gene defects

Hemolytic

24
Q

Congeital/ Hereditary RBC G6PD

ketchup

A

Race: black or mediterranean
X-linked men
Oxidized stress can make heiz bodies (dotes in rbc)
spleen pit cells make bite cells (someone bit RBC)

Hemolytic

25
Q

Sickle cell anemia

A

Reason: Beta chain missense = homozygous Hb s cells, different types: Bo severe, B+ not as sever, HbC not as severe

Symptoms: Chronic hemolytic anemia, Chronic pain syndrome, dependent on O2,pH, Temp, Hgb conc., fuild , SPLENOMEGALY all have

Etiologies: sickles shaped RBC plug up small vessels (+90% of RBC), High Hb F helps bind oxygen better

Crisis:
1. Acute chest syndrome: blocking of pulmonary vasculature - fever hypoxiam chestpain and pulm infultrates
2. vascular occusion: obstruction of all blood vessels
3. Aplastic: B19p - decreased RBC production
4. Splenic sequestration: massive splenic pooling

p like sphereocytosis

Hereditary, Hemolytic

26
Q

Sickle Cell treatment

A
  1. Hydration
  2. immunizations
  3. Infection
  4. Pain
  5. Transfusion
  6. Stem cell Transfusion
27
Q

Hb C sickle cell

A

Beta 6 glu to lys
homo = sickle
heter= okay
africa more common

28
Q

Hb E sickle cell

A

Beta 26 glu to Lys
Thalassemia type blood and smear
Southeat asia more common

29
Q

Aquired hemo anemias

A

Most common hemolytic anemia
Cause:
1. immunune
2. infection
3. external agents
4. hemolysis by mech valvue destrciton by factors in small blood vessels

30
Q

Immune-mediated hemolytic types

A

Antibody/ complements bind to RBC = hemolysis
1. Warm IgG
2. cold IgM
3. Transfusion - ABO

hemolytic

31
Q

IgG Hemoltyic

A

Reason: warm temp triggers IgG to bind

Symptoms: hemolysis and anemia

Etiologies: can be caused by secondary or idiopathic (spontaneous)

Labs: Sphereoctyes, positive DAT for IgG

32
Q

IgG Hemolytic Treatment

A

Steroids, rituximab, immunosupiression

33
Q

IgM Hemolytic

A

Reason: 4 degrees triggers C3 to appear and cleared by macropahages

Symptoms: Hemolytic anemia

Etiologies: Can come from: Mycoplasma pneumonia, EBV
Lymphoproliferative disorders ( replicating white blood cells)

Labs: Smear - agglutination (clumping), DAT for C3

34
Q

IgM Hemolytic treatment

A

Immune supression or treatment of secondary disorders ( mycoplasma pneumonia or lympho prolife

35
Q

Fragmentation Hemolysis types

A

How: mictoangiopathy by mechanical trauma of Fragmented RBC
Types
1. Disseinted intravascular coag - infection, sepsis, burns, cancer
2. Thrombotic thrombocyytopenic purpura
3. hemolytic uremic syndrome

OVERALL DMG TO RBC in the microvasular area

36
Q

Disseminated intravascular coagulation (DIT)

A

Infections trigger inflame and body responses but cant do proper anticoagulation = microvasular thrombosis

usually to do underline systemic problem

Hemolytic

37
Q

Thrombotic Thrombocytopenic PurPura (TTP)

A

During dmg VWF clot and ADAMTS13 breaks down the VWF after the tramua.
in this case DEF IN ADAMTS13 and this cause unfolded VWF to bind to RBC and cause clots

usually idiopathic

you see Schistocytes

38
Q

Schistocytes

A

Spit RBC that indicate: microangiopathic hemolytic anemia

Usually seen in TTP

39
Q

Paroxysmal Nocturnal Hemoglobinuria

A

Reason: genetic mutation in a hematopoietic cell - PIGA gene ( resonsible for 1st step in cell attachment GPI def)

Symptoms: dark urine at night a give away can be from thrombosis or bone marrow failures

Etiologies: anemia with mostly intra with some extra

Labs: Flow cytometry to look of absent of GPI

heme (6 decks)

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